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The Obamacare Shock

What if it actually works to reduce the costs of US healthcare?
The program’s a looming non-disaster!
Jon Piehl's profile photoDana Blankenhorn's profile photoChris Nandor (Pudge)'s profile photoFloris Kraak's profile photo
It probably will reduce costs. Here in the Netherlands we just went the other way about 5 years ago, moving from public to more private healthcare and the costs are simply spiraling upwards. Privatising is not always the best option.
really, we are playing that game now?

There are lies, damn lies, and political opinion pieces.
Well, fancy that. Can so many right wing pundits actually be wrong?
I was part of that test case in California and I have excellent coverage and at a lower price than anyone else I know. It's true.
That would be great because my health care premiums have gone up the past two years.
Republicans will complain anyway.
ObamaCare will cap max deductables at $3600 per family. For private policy holders, too. How many current policies have caps higher than this?

This is just one example of mandated changes for all Americans will cost a ridiculous amount of money, which insurance companies will have to pass on to employers, which one way or the other will impact employees in payroll deductions or as higher unemployment when demand for labor decreases due to medical insurance costs.
Krugman believes digging holes and refilling them is real work. This man cannot be trusted, as every single one of his stances in the past couple of decades has caused bubbles and crashes. I didn't read the article, I just saw the picture, and that was all I needed.
Krugman is mostly drawing on the actual experience in California. It's not a political screed decrying something the author knows nothing about. Read carefully and you will see that he is not making categorical statements.
Personally I'm looking forward to it based on my wife and son both having preexisting health issues. As a contractor, I am still covered on COBRA until the end of the year however if I were to get a private policy on my own, my premiums would be around 2K a month. With ObamaCare I don't have to worry about the exclusion of services related to these preexisting conditions for my family.
+Scott Tooley Likewise; I only have to see you dragging out the old "digging holes" trope in order to realize that you are ill-informed and probably not interested in actually evaluating economic reality. You might look up what was actually said.
Jim Nutt
I think cost transparency would do more to reduce costs than any thing else the government can do. Most people have no idea how much their health care actually costs (other than their insurance rates) and it's very nearly impossible to compare costs across providers. I think if people knew what the costs were and were responsible for minimizing those costs, the costs would fall.
Marc P
I'd like to see real sound examples of privatisation actually lowering costs while maintaining or increasing quality
I fear that people will judge success of the program based on their local experience. Someone in Texas is going to judge the program to be a failure because, as implemented in Texas, it's likely to be. They're not going to look and say "hey... everything is awesome on California - our politicians are out to screw us, vote for the other guys!"
We have been seeing a reduction in medical inflation ever since the bill was signed. Large insurers have even bought heavily into Medicare pools. Those in the "insured" pool are likely to be the better risks, and if there's real competition -- not the fake kind we've had in many states --- then rates will come down. 

That's the experience of Massachusetts, it seems to be the experience in California, and if the U.S. government is able to run exchanges for those states that have refused so far -- with the subsidies that are supposed to go only through state exchanges -- everyone will benefit. 
+Marc P Look around the world -- there are dozens of examples of this happening.  For instance, check out the history of Entel in Argentina.  
Your optimism is adorable, Tim.  ObamaCare is a train wreck.
+James Day Any evidence other than your feelings for that? Medical inflation is down, the prices being charge in California are reasonable on the exchange, millions more are now covered, pre-existing conditions are covered, and insurers are now buying Medicare companies, which serve high risk pools. 

So where;s the train wreck?
+Jason Shultz How fast have they gone up? Medical inflation has slowed, and if your carrier doesn't use 85% of your premium for actual care they have to refund the balance to the insured -- maybe your company. 
+Jake Bishop I know that's what your political leaders tell you, but it isn't happening. The bill has been law for over 2 years and your fears haven't been realized. What will it take to get you to understand that the liars were those who opposed the bill? Or are you so loyal to your tribe that facts don't matter?
+Jim Nutt Guess what's bringing you some cost transparency? The ACA, the health care bill. The OBAMA Administration. (sheesh)
+Scott Tooley That's what your tribal leaders want you to believe. Anyone who disagrees gets dehumanized, then ritualistically ignored by the flock. You're a victim of the Koch Brothers and the rest of hte billionaires. 
+Jake Bishop I can understand if you don't want to engage in reality. What if you found out you were being lied to, systematically, by a bunch of billionaires? It would blow your mind. You don't want it blown. Fair enough. 
No wonder gay marriage and abortion on demand is supported. Acceptance of gay marriage justifies the need to clone "test tube babies". Abortions and otherwise curable cancer medical waste supplies the human cloning factories with human cells to grow the blanks. Blood donations and plasma are also needed to clone humans. Your public evidence is James Holmes in Aurora. 
Nephilim clones can be seen at NFL games. We didn't get taller because of growth hormones in milk. That came from DNA extracted from the nephilim bones found in N America. The bones are in the library. Paid disinfo agents minimize and seek to label those insane who tell the truth. The bones are online at the Smithsonian etc Atheists and cult killers want this ignored because it proves the Biblical story of David vs Goliath as truth not fantasy.
Great gnashing of teeth ....
I've never received a refund on my insurance premium. I've heard this story before about how they are supposed to but in reality it's never happened to anyone I know. I'd be willing to be that they found some way to define "actual care" as anything they want. Insurance companies are good about that. Thousands of attorneys and lots of lobbying dollars to be spent to keep things the way they want it.
And it proves movies have had real murders and that those crushing hits at NFL games resulted in the death of a NFL player and the coverup and replacement clone.
And you all thought Iraq just had men who "looked" like Saddam. A double. Sure he was. Try a clone programmed to believe he was Nebuchadnezzar reincarnated. MK ULTRA did that. Gotta go muppets. Your programming is causing you to ignore what I wrote. I'm sorry but I am also not responsible for what was done.
Marc P
+Matthew Morrison O'Connor check out water privatisation in London... Complete disaster... Telecom privatisation in Germany... Complete disaster... Public transport, energy, health services and the list goes on. There are endless examples of the complete opposite. Picking examples of broken ex socialist directed economy companies which now work because they were fundamentally dysfunctional before privatisation is no proof of concept. Privatisation is in no way beneficial for services which should benefit the public and not be aimed at profit maximisation as these two goals fundamentally contradict each other.
There's little in the bill to reduce health care costs.  The only real way to reduce costs is competition, and "Obamacare" reduces competition.

We need consumers of care to be culpable for the cost.  That's the only way to get costs down, short of total control of prices (which has its own many problems, which are far worse).  History has proven this time and again.
+Dana Blankenhorn The ACA helps with some transparency, but a. very little and b. it doesn't do the other essential part, which is making the consumers of care responsible for the cost.  If I can see the cost is $100 for this pill and $10 for that one, so what, if my out-of-pocket is the same either way?
+Dana Blankenhorn I'd be much more comfortable with the ACA if it hadn't been rammed through without proper review. Four years on and we're still finding out what's in the bill.
Well, don't forget Jim, they said they had to pass the bill before they could find out what's in it. . . Or was that the Patriot Act? 
Yesterday I went to a routine appointment at my specialist office (a large multi-doc practice).  They were scrambling with some irritation to get all their medical records to electronic format per ACA requirements.  This is long overdue.  My PCP office has been electronic for some time allowing lab test results to be available on their portal, etc.  If nothing else, ACA will force modernization of medical records.  I cannot comment on the quality of their software programs.  My doc says they have to change how they do things to suit the computer.
James Day, patronising comments like yours, and the use of buzz words to justify your point seems so out of place here. I'm impressed with this thread since it generally shows what we are missing presently: support for some who need healthcare and the desire to ask, "how can I help" rather than comment, "it's not going to work". The latter comment I find is more about the person speaking than the issue...unless you are a politician, then I suppose its your job to nay-say. Either way, I'm curious what you expect from your comments and also perhaps what you expect from others who have opposing opinions to yours?
That's the spirit, Casey! Fuck the poor! All of them are lazy freeloaders! Everyone knows that if you work hard, you automatically make all the money you need to support yourself and your family. I'll grab the pitchforks, you bring the torches. Let's do this the old fashioned way. We're all just animals anyway right? Survival of the fittest style.
+Eric Franca I won't defend what Casey wrote, but I believe -- due to the evidence -- that the best way to help the poor is the free market.  We have not had a free market in health care for decades (my whole lifetime, essentially).  Government gives massive tax incentives to companies to pay for my insurance, which inevitably drives up rates, as consumers are dissociated from prices.

The best way to help the poor is not with "hey, free health care!" (which won't happen as much as you might think under the ACA, as we're going to have health care shortages ... insurance is fine, if you can get someone to accept it in exchange for services), but "hey, affordable health care!"

We see this happening now.  We see Lasik surgeries and independent health clinics and other health care services with cheap prices, because they exist in the market without insurance.  Insurance (as it is currently constituted) drives up rates, and putting more people into the insurance pool without making the people in that pool more responsible for costs will drive up rates more; at the very least, they will continue to increase unsustainably.

We do not need a slowing of growth of the cost of health care, we need to lower costs.

We see the same thing in the cost of college.  The prices are insane, mostly due to government intervention that reduces price competition.  This isn't a mystery, how it works.
(And it's an interesting coincidence that the reconciliation bill that made the ACA law also massively increased government control over student loans, making those loans much cheaper for the students.  The Senate never even debated this massive change ... it was, like the ACA itself, a bill that most legislators never read and increased government control and reduced individual responsibility for costs, thereby inevitably leading to further increased costs down the road.)
Screw What if?   I need Science.  Roll it out in a small area.  Run the experiment for a year or so, collect evidence.  Compare to the control group(s).   ONLY THEN should we make a law that affects the entire populous.  Damn Dirty Apes are running the whole world.  Humans have Science!  Evolve mentally and USE IT.
Tim Landers, so look at Massachusetts?
It's much easier to point out costs from subsidizing corn production of HFCS leading to it being used as an additive in almost all food.

Resultant obesity and onset of adult type diabetes results in more risk in younger age groups.

The numbers have flipped with cheap food and expensive healthcare. Food used to be expensive but was also more local. Insurance simply deals with pooling risks. It doesn't lower healthcare costs from a sicker than normal population.

+Chris Nandor Can't agree with you. Handing the free market the keys to healthcare is like setting wolves loose in a sheep factory. I have no confidence in insurance/healthcare companies before ACA or now...let alone if they're left to "compete" with each other. In areas where the free-market is in action, it works great!...for the people who have money to pay for it. I'm not saying the ACA is the best solution, I just think it's a nice push in one direction that could solve a lot of people's issues in this country. 
+Jason Shultz If the insurer is paying 85% of premium out in services, there's no rebate. If the insurance is bought by your company, through your company, the rebate goes to them. The point is the law now says a certain percentage of hte premium must be paid back in services, and it didn't before. 
+Chris Nandor Uh, no. What are the insurance exchanges? Competition. What does price transparency create? Competition. Price increases are slowing, have been since this bill was passed, have been in Massachusetts since Romneycare. 

The most important point of both bills is maintenance. If you do regular maintenance on your car, it runs better, costs less, doesn't break. Same thing applies to you. Mandating care, getting everyone into the pool, provides incentives -- MARKET incentives -- for accountable care organizations to do that regular maintenance on you, and so reduce costs. 

It works. 
+Jim Nutt Oh, please. This was thoroughly debated before passage. Information on the new law's impact has been going out all along. You close your ears and then blame the orchestra for not blasting through them?
+Casey Duckworth I had no idea that the Heritage Foundation was a socialist plot. They designed this. This was originally proposed by Richard Nixon, then offered by Bob Dole as an alternative to "HillaryCare" in the 1990s. 

This regulates insurance companies. It is market-oriented regulation, of a sort we've had in this country since the 1880s. If this is socialist, so was Grover Cleveland. 
A universal and free health care system is the only option for a civilized society we should all thrive for it.
+Eric Franca says, Handing the free market the keys to healthcare is like setting wolves loose in a sheep factory.

That makes no sense.  Your fears are not based on facts or reason.  The free market gave us affordable care before WWII, and it gives us affordable care today.  It's only in those areas where government-subsidized insurance pays for care, where care is vastly overpriced.

I have no confidence in insurance/healthcare companies before ACA or now...let alone if they're left to "compete" with each other.

You have no confidence in what?  That prices will come down and quality will go up?  Because that is precisely what competition does.  What exactly are you afraid of?

In areas where the free-market is in action, it works great!...for the people who have money to pay for it.

Um.  Right.  And the free market will make it so more people will be able to have the money to pay for health care.  That's what the free market does.

I'm not saying the ACA is the best solution, I just think it's a nice push in one direction that could solve a lot of people's issues in this country.

It will solve some issues for some people, while creating more issues for even more people (through lost choice in care, and continually increasing costs), and -- due to doctor etc. shortages -- will not help as many people as it promises to.
+Dana Blankenhorn That's an old wives' tale.  It's only barely based on facts, but rather a twisting of them.  Yes, Heritage pushed for a similar system, but a. not this one at all (there's far more differences than similarities), and b. they didn't originally propose it, as it predated their proposal by many years.

And my goodness.  You think the exchanges are competition??  You cannot be serious.  You are required to be a part of the exchange, as a seller or consumer of insurance.  You are required to be a consumer of insurance.  Most insurance features are mandated, and there's a cap on the services provided.  There's price controls on the cost of the insurance.

Every objective observer has said that the ACA will result in a homogenization of health insurance options, both in that the law requires them to be more similar in nearly every important way, and in that smaller insurers -- due to the lack of ability to compete on services and costs, due to the mandates -- will simply go away.  You will have less choice and less competition due to this manufactured and mandated "market."

What does price transparency create? Competition.

As I already pointed out, that's only true if the people who are making the choices are the ones impacted by the prices, which is not the case today.  Yes, businesses choose insurers for their employees based on prices, but consumers usually do not make any choices based on price, no matter how transparent the prices are, because the consumers don't pay that price (or, they don't pay it directly).

No, price transparency in health care can only work to create competition needed to drive down costs if the consumers of care are directly responsible for the costs.  That's why some insurers are going to high-deductible HSA plans -- to get the consumers more involved in price-based choice -- but this is only a partial solution.

Price increases are slowing, have been since this bill was passed, have been in Massachusetts since Romneycare.

But they are still increasing unsustainably, whereas a free market would make prices actually decrease.

The most important point of both bills is maintenance. If you do regular maintenance on your car, it runs better, costs less, doesn't break. Same thing applies to you.

And I get to choose whether to purchase maintenance for my car, and how to pay for it (as soon as I am done writing this, I am leaving to get my tires rotated, and that's not a euphemism!).  You're just emphasizing the fact that you're a statist who doesn't believe in freedom, rather than making a serious case for why the bill is reasonable.

Mandating care, getting everyone into the pool, provides incentives -- MARKET incentives -- for accountable care organizations to do that regular maintenance on you, and so reduce costs.

First, I don't buy it as a theory.  I've heard it before, and I've read the studies, and I understand the theory.  But I was taking my pills before the bill passed; now that they are free (on the basis that if they are free, I'll be more likely to take them, thus saving money), it doesn't provide any such cost savings.  Maybe there's people out there who aren't taking these (inexpensive) pills because they cost money, and will now that they don't, but the impact on overall costs will likely be small.

I am not saying preventative maintenance doesn't save costs.  I am saying that there is no strong evidence that these mandates will result in a significant increase in preventative maintenance such that costs will actually be saved.

Second: those incentives to reduce costs exist almost completely apart from the ACA!  You really think a company needs a government incentive to lower its costs?  Come on.  The ACA did very little to change the incentive structure.  We did see some changes, like allowing outcome-based models, but that itself is far from a clear positive, and could be a net negative for health care outcomes.  My daughter went for years with an undiagnosed condition, and the doctors did a lot of work on her, and it's easy to see how they would have been de-incentivized to work on her at all, in an outcome-based model, where there is little chance of success from the outset.

(Indeed, we did see some doctors essentially give up on her because they couldn't figure out what to do next.  If their compensation is more directly based on outcome, that becomes a far more common occurrence.)

Finally, this -- at best -- pales in comparison to the cost savings provided by the free market when consumers are making price-based choices.  The free market "magically" (it seems like magic, but it's simple human behavior) gets us lower prices, increased quality, and broader availability.

It works.

It really does.
The point where you lose interest in an internet conversation that serves no purpose but to satisfy a perverse desire for internet arguments...I'm there. Do internet conversations ever change anyone's mind? I think that's something everyone can agree on. Great. Cheers.
+Eric Franca Please.  The point where you lose interest is where you realize that you don't have a rebuttal.  Otherwise, you wouldn't post a comment that you aren't going to post another comment, you just wouldn't post another comment.

"Internet conversations" do not exist for me.  I have conversations, period.  And yes, those who are close-minded never have their minds changed.  That's not new, and not exclusive to the medium.
Since everyone is going to be covered all hospitals can immediately reduce costs by half, since they double their prices to pay for all the uninsured people... at least that is why they claim they have to charge so much now.
+James Rogers That's one intent of health reform. But conservatives arguing for price transparency should be glad the Administration has forced the release of pricing information, which varies considerably by hospital.
How can the costs be higher if there are no longer any uninsured people that have to be covered at full cost?
+Chris Nandor You're just wrong. Heritage did write the original plan. The cost increases are abating. And competition is coming BECAUSE of the law, not despite it.

Regulated businesses can compete. They do this quite well in places like Germany and the Netherlands, where mandatory insurance plans have been in place for many years. 
+Dana Blankenhorn says, You're just wrong. Heritage did write the original plan.

Um, no.  They didn't.  That's a common line, but it doesn't bear even modest scrutiny.  The ACA bears very little resemblance to the Heritage proposal, so you cannot mean that Heritage wrote the actual plan, but rather, that they came up with the idea of individual mandates.

But they didn't come up with the idea.  You can't think no one thought of requiring everyone to have health insurance as late as 1989!  Japan did it in the 60s, I think.

The cost increases are abating.

The costs are increasing.  If we had real competition, they would be decreasing.

And competition is coming BECAUSE of the law, not despite it.

You base this on ... ?  Please, share with us, what competition is increasing specifically because of what part of the ACA?

Regulated businesses can compete.

I never said otherwise.  I didn't say they cannot compete, I said the opportunities for competition are massively decreased by this bill ... because that is so obviously and plainly true.

Due to a high "minimum coverage" requirement, they legally cannot compete on low-cost options for people who need few services; due to a penalty on "too much" insurance, the options for "Cadillac" plans is decreased; due to cost controls, their options for competing on price are severely limited; because you can only buy insurance in the "exchanges," it reduces various kinds of options for competing through marketing.

Increased regulation usually means less competition, but when that regulation takes the form of massive control over what services must be offered, what you're penalized for offering, what prices will be, and even where buyers and sellers can do their interactions ... that necessarily, every single time, will reduce competition, as it has and does here.
+Chris Nandor Keep spreading that disinformation. Reality will eventually intrude, even into you. It just takes time when you're dedicated to your tribe.
+Dana Blankenhorn When I provide reasoned arguments and instead of rebutting you pretend that you don't need to, the rest of us know you're simply incapable.
I'm amazed there is opposition to Obamacare at all. We have had mandatory nationwide public health insurance over here in the Netherlands for decades, and It Just Works (tm).

Too many people, especially Republicans, think that Market Pressure is the end-all-be-all solution to every problem, and the goverment should regulate absolutely nothing.

Well, welcome to reality: Sometimes, market forces are not the answer - they are the problem.
+Floris Kraak If you're amazed, then, clearly, you do not understand our objections.  If you did, you wouldn't be amazed.  Perhaps you should work on that?  I mean, I understand why you like the mandate, so why it is it you can't understand why I object?

Here's your first challenge: realize that something "working" isn't always an indication that it's a good thing.  As a (only slightly) extreme example, consider that significant loss of liberties in Singapore have led to decreases in crime; to me, that is not a reasonable tradeoff.  Everything government does is tradeoffs.

Consider that I know lots of people, young and old, rich and not, without children who pay for most of their health care out of pocket, and get less expensive high-deductible insurance.  They will pay more.  They will be forced to purchase insurance they do not want and do not need, for the sole purpose of making them pay for the health care of others.  While it may be reasonable social policy, it's bad fiscal policy (welfare treated like actual welfare works better than doing it this way).

There is not an example of the free market not working, and you can say it won't work, but you can't back that up with an argument.  (Also, for the record, you are either ignorant or dishonest when you say Republicans think government should not regulate anything; hell, we're not even saying government shouldn't regulate health insurance, but that it shouldn't mandate its purchase).

We know as a fact that getting rid of the corporate tax deduction for health insurance benefits will lower the cost of health insurance from what it otherwise would be, by a lot.  We know this, absolutely: it would generate far more competition (because individuals would be empowered to purchase insurance on their own, at the same rates as their employers, and they would shop around), which we know decreases prices.

Further, we know as a fact that high-deductible plans, where insurance is used only when necessary, reduce the cost of health care, because, again, individuals generate competition when they are paying out of pocket.  And that, in turn, reduces the cost of insurance.

The problem is not, and never has been, the number of people without insurance.  The problem is providing health care to people who need it.  And the biggest barrier to that is high costs.  So for that reason -- and because it would boost the economy all around -- we should be focused on reducing costs, first and foremost.  That would also make a mandate less painful, even if we had one ... but if costs are reduced, there's less of a need for a mandate, because people are more able to provide health care on their own, with reduced costs of insurance and care.

So ask yourself why we didn't do those things.  After all, it works.

Finally, and perhaps above all, the health insurance mandate, and most of the Affordable Care Act, are unconstitutional, regardless of what John Roberts says.  And even if you don't think it is, what is beyond clear is that it violates the principles of the Constitution: this is none of the federal government's business, and if it is to be done at all, our laws say the states should do it.
+Floris Kraak Our +Chris Nandor believes the lies his Koch overlords tell him on Fox news. 

The health market needs to be organized and regulated if it's to provide competition. That's what the ACA does. It regulates the market, and it organizes it to guarantee competition. 

We have too many people in this country who seem to think that an unregulated monopoly equals "Freedom." It does not. It equals "Fascism." 

In most states, before the ACA, there were just one or two health insurance providers, who could charge what they wanted, take as much profit as they wanted, and cherry-pick the best risks.

This President ended that. And the Koch brothers hate it. So they have told their minions, like +Chris Nandor, to hate it. And they hate it. 
+Dana Blankenhorn You've only explained WHAT the ACA hopes to do and accomplish. I'd be interested in the HOW you think it will accomplish those goals. Explain the economics behind your argument.

I think most people want better access to better healthcare, but we have to make sure our good intentions don't lead us down the wrong path.

Just look at the cost of higher education in the US. It's highly regulated and highly subsidized by the government but prices are out of this world.

You have to look at the long term impact of policies not just the short term benefits.
+Dana Blankenhorn Wow. Not only do you refuse to engage my arguments, and only do you then resort to an obvious genetic fallacy, but you even invent a bogeyman to be the object of that genetic fallacy.


The health market needs to be organized and regulated if it's to provide competition.

Yes.  And?  The free market does a far better job of organizing and regulating than government does, so you're not making a case.

That's what the ACA does. It ... organizes it to guarantee competition.

You're lying, +Dana Blankenhorn.  The ACA has not a single provision in it that guarantees competition, and worse, I already clearly and plainly described how it reduces competition ... but you refuse to acknowledge the case.

We have too many people in this country who seem to think that an unregulated monopoly equals "Freedom." It does not. It equals "Fascism."

Wow.  You are just on a roll.  There's no "monopoly" at issue here.  Even the proponents of the ACA acknolwedged that the ACA would reduce the number of players in the health insurance market; if anything, the ACA gets us closer to a monopoly system than what we have now, and there is no question that reducing regulation would give us even more options: the ACA necessarily reduces options by providing penalties for falling outside defined minimum and maximum coverages; where smaller players could come in and offer tailored coverage, they get eliminated when the options for the market are pre-defined by government.

But even worse, not a single person said that we should have a monopoly.  Not even hinted it.  No "people" think this, let alone "too many people."

And even worse than that, it is not possible for a private monopoly to equate to "fascism."  No matter how you define fascism, it comes from government through force, not private enterprise.

In most states, before the ACA, there were just one or two health insurance providers, who could charge what they wanted, take as much profit as they wanted, and cherry-pick the best risks.

Name a single state with merely "one or two" health insurance providers.  You're lying.  Even if a few states have that few, it certainly isn't most.

My state has exceptionally few poviders, but it still has more than two.  And the reason it has so few is explicitly because of government regulation.  We had far more providers before the state government increased regulation and drove them out.

And even worse, the ACA does absolutely nothing to increase the number of health insurers in a given state.  You're lying about that, too.

This President ended that. And the Koch brothers hate it. So they have told their minions, like +Chris Nandor, to hate it. And they hate it.

I've hated the health insurance mandate since long before most of the country even heard of it; please, do yourself a favor and stop lying.  Seriously, you only make yourself look like an ass.  Maybe that's apt, but it still isn't wise.
+Jon Piehl The law is in the process of being implemented.So far, all  promises made for what has come into force have been  realized.
 I'm not going to re-legislate what's in process. Yes, I realize it will be imperfect. All laws created by legislatures are compromises, hence imperfect by the lights of most people. 

This law is working. Kids can stay on parents' policies. A host of basic wellness services are now free. Insurers must pay out 80% of premiums in the form of services. The rate of medical inflation is declining. Just three quick examples. There are other provisions -- look them up yourself. 
There are two basic elements to the health care law.
1. An ounce of prevention is worth a pound of cure -- We must pay for basic wellness services. Just like a car breaks without maintenance, same with you. We all require maintenance. It pays for itself.
2. Everyone into the pool. The highest-risk pools are being taken out of the market -- the elderly, the poor, and veterans. (Serving them costs less when done through the government, and we have decades' of proof on that.) Everyone else gets into the pool either directly or with some subsidy. Community rating means you don't get dinged for things specific to you, like pre-existing conditions. The requirement for services means young people -- who are paying more for health care than they need -- can still get extensive wellness service. Which will cut costs down the road. 

Not that damned hard to understand. This is what medical experts have been telling us for decades. This is what works everywhere else, in the civilized world 
Funny how +Dana Blankenhorn claims it's working and doing what they said it would, while giving an example of a broken promise: we were told time and again -- most of us knew it was a lie every time they said it -- that the ACA would bring costs down. He concedes that isn't happening, that costs continue to rise, which means that, in the case of costs, it isn't working and it's not doing what they said it would.

1. +Dana Blankenhorn makes no serious case here. I pay for maintenance on my car when I need it, not up front. There's no need to pay up front, as he claims.

2. He falsely claims the reason to put everyone in the pool is so they will be covered if something happens, and for maintenance. No. The mandate exists for one reason only: because most people not in the pool don't need to be for their own sake, and we want to use their money to pay for other people. That's it. It is, literally and explicitly, wealth redistribution.

+Chris Nandor You need the extended  warranty for yourself. Everyone does. You claim it's a "choice" you don't have to pay for "up front," but that's just not true. When you don't get check-ups and wellness care, you get sicker, cost MORE. You say, then, tough shit, but that's not how medicine works. 

Before the ACA, millions of people were clogging emergency rooms, demanding care, getting care, and you were paying for it. Now, there's a mechanism for everyone to get wellness care, lower costs, cost you less in the long run, and you call it "wealth redistribution." 

It's not. It's how the world works. Canada, Europe, and Japan pay HALF what we do for health care, as a percentage of GDP.  That's a huge advantage for businesses there. They also live longer, on average, than we do. 

Since the ACA was signed medical inflation is slowing. More are getting care. More are getting the preventive care that lowers costs down the road. Massachusetts is further down this road than the rest of us. They prefer this system to what they had before. 

You may not think that's a "serious case," but that's reality. 
You think Bill Gates needs insurance. That's what you said. It's obviously false, but that is the case you're making. That isn't serious at all.

It's not about not getting maintenance, it's about how I pay for mine. It's wealth redistribution, obviously: otherwise a mandate would be unnecessary. People with means don't need to be forced to buy insurance, if they want it. And if they aren't getting "maintenance," they won't get it just because they were forced to pay for it, because they could already pay for it if they wanted it. The mandate is all about forcing people to pay money into a system for other people to use that money. Period.

The people clogging up ERs are not those who need to be forced, they are the ones who cannot afford it, and they can afford it even less now, as costs have continued to rise. And people will still be clogging emergency rooms because there aren't enough doctors. Which will also increase prices, of course.

And I don't know why you keep pointing out the fact that with the ACA, costs are still increasing, despite the promises that they would decrease. You're only hurting your case.

+Chris Nandor Here's a word you don't understand. Responsibility. We have a responsibility to deal with our health. Bill Gates has it. I have it. You have it. And when you deny that, you're freeloading. If you intend not to buy insurance, you're intending to take health care and make me pay for it. That's what was happening before the ACA. 

Your "option" of telling people without insurance to die is the stance of someone who sees no responsibility for being within society, the society which protects you, which guarantees your freedom, and without which you are no more free than a Somali refugee. 

Don't like it? Please leave. There are lots of good people around the world who will gladly take your place as Americans. And they'll do better by this country than you're doing with your blathering and your refusal to accept responsibility and your calling license "freedom."
+Dana Blankenhorn says, Here's a word you don't understand. Responsibility.

You're lying.

We have a responsibility to deal with our health.  Bill Gates has it. I have it. You have it. And when you deny that ...

You're lying.  I never denied anyone has a responsibility to deal with their health.  In fact, contrary to your lie, I said my point isn't whether we get "maintenance," but how we choose to provide it.

You're the one denying here: denying the simple fact that you lied when you said we "need" insurance to provide our "maintenance."  That is an obvious lie.  Bill Gates can pay out of pocket.  He doesn't need insurance.  Your claim that he does is a lie.

If you intend not to buy insurance, you're intending to take health care and make me pay for it.

You're lying, obviously.  My choice to not buy insurance simply means I will pay for health care out of pocket.

That's what was happening before the ACA.

You're lying, obviously.  Many people chose to not buy insurance, because their risks were low and their means were sufficient that they could pay for themselves if necessary.  More often, people simply bought catastrophic coverage, paying for all maintenance out of pocket.  MANY people do that.

You're simply lying when you say they made anyone pay for them.

Your "option" of telling people without insurance to die ...

You're a damned liar.  I never said or implied any such thing.

Don't like it? Please leave.

Fuck you, +Dana Blankenhorn.  You lie about what I say, you lie about what the ACA does, when confronted with arguments exposing your lies you never address them, you tell lie after lie after lie, and then -- based on those lies -- you say I should leave my country, the very country whose Constitution you piss on just because you don't like what it says.

Fuck you.  You're a damned liar, and a total fool.  But worse than all that is the fact that you reject the fact that people don't need government, or insurance, to provide for themselves.  You're fucking insane.
Calling someone a liar because they call you on your bullshit is bullshit. 
+Dana Blankenhorn says, Calling someone a liar because they call you on your bullshit is bullshit.

True.  But I didn't do that.  I pointed out specific lies you made, and showed that they were lies.
+Chris Nandor My comment about "Too many people, especially Republicans", wasn't intended to target all Republicans. Just that much of the time people who feel that way tend to vote Republican.

Now. I agree that the fact that the system we have in the Netherlands seems to work for the Netherlands doesn't, on it's own, mean it's a good thing. I feel that it's been a good thing for us, and since it's almost a matter of national pride how well it works, there must be some reason why we feel that way. However, I am willing to concede the point that that, on it's own, isn't proof.  I thought it was a useful data point, however.

Regarding making people pay for the healthcare of others: Yes. That is exactly the point of it. I don't think I understand why you think it's a form of welfare; It's not. It's just a way to redistribute the cost of health care in such a way that it levels out between people in good and in bad health. This is basically recognizing that people don't deliberately have bad health, and since it's a problem that everyone is likely to be confronted with at some point, it's good to make everyone pay for that, whether currently affected or not.

And I don't think that that is bad fiscal policy, either. Dollars spend on healthcare tend to be sound investments. Having people stay productive for longer tends to pays for itself. Already being covered when your health declines means that there is no financial barrier to going to a doctor early to have your problem looked at. Which means that more problems get caught early and solved better for less money.
So sure, it may not be a "great fiscal policy" in the short run. But if you consider it on a 50 year scale, I think it's actually going to be a net positive.

Now. Regarding corporate tax deductions: I have absolutely zero knowledge of that, so as far as I'm concerned you may be right. Or not. I have no way to know.

The rest of your comment is pretty much covered by the above.
Lowering the barriers for people to go and get healthcare is more important than 'competition' that can be had in other ways.

Especially the argument that competition will exist when people have to buy healthcare "as needed" - Right. Buying health insurance only when you fall ill. I can see that working right now. "Oh, you have this pre-existing medical condition? Well, here's the effect on your premium .."
That's not insurance. That's just another indirect way to pay your hospital bills, with a middleman that takes a profit on it in between.

Your focus on 'driving costs down' is the accountant's view of health. You just see a column of numbers, tot them up, and say "this is expensive". Of course it's expensive. Doctors don't grow on trees. Nor does scientific research. But if a few hundred dollars a month extra costs will ensure that somebody will remain productive for 10-20 years more than they otherwise would, that money is going to be well spend.

Finally, regarding the constitutionality of it: Your own Supreme Court disagrees with you, and thet are far more qualified to give an opinion on the matter than either of us. That is enough for a silly foreigner like me. :)
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